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Subcutaneous emphysema: cause, symptoms and treatment

Emphysema is a lung disease, but, here we shall talk about subcutaneous emphysema. Subcutaneous emphysema is the build-up of air inside the subcutaneous tissue. There are various causes of subcutaneous emphysema such as rupture of oesophagus or lungs tissue.

These are the sites the air travel from and reach to the skin tissues. The symptoms of this condition are coughing, wheezing etc. Subcutaneous emphysema treatment includes surgical removal of air from the tissue and administration of medications. To more the things in detail, go through the following article.

What is subcutaneous emphysema?

Subcutaneous refers to the tissue below the skin, whereas emphysema refers to build up of air. Hence, whenever air is or build up inside your tissue beneath the skin, we call is subcutaneous emphysema.

This medical condition is also known as Hamman’s syndrome or Macklin’s syndrome by some people. It is because; Dr Hamman and Macklin contributed a lot to understand the pathophysiology of this disease.

Signs and symptoms:

You may subcutaneous emphysema for years, but you may not even realize that you really have.

If you feel signs and symptoms of subcutaneous emphysema such as difficulty breathing and cough, whenever you do any physical workout, you may have emphysema. Rule out other medical conditions to confirm it.

Subcutaneous emphysema gives a peculiar feeling when you touch it. The touch sounds like touching a rice krispies. Such sensation of air beneath the skin is called as subcutaneous crepitation.

Here is a list of signs and symptoms of subcutaneous emphysema:

Swelling of the neck

Chest pain

Exhaustion

Depression

Weight loss

A sore throat

Neck Pain

Difficulty swallowing

Wheezing

Breathing difficulty

Air in the mid of chest cavity

A feeling of fullness around the neck

The sound of the voice changes

If you have a severe case of subcutaneous emphysema in the neck and chest region, you may have difficulty breathing while swallowing.

These are the common signs and symptoms of subcutaneous emphysema

Subcutaneous emphysema infographics

How does subcutaneous emphysema form?

It is possible for the air to move to soft tissues of the neck from the mediastinum. Moreover, air can even travel from the retroperitoneum. Retroperitoneum is the space at the back of the abdominal cavity.

Whenever, the lungs tissue ruptured, air from the ruptured tissue can move into perivascular sheath and mediastinum. From mediastinum and perivascular sheath, air can finally travel up to subcutaneous tissue.

Spontaneous subcutaneous emphysema has no known reason. However, there are predictions of its cause.

Studies shows, in case of spontaneous subcutaneous emphysema, can arise due to increased pressures in the lungs. The increased break the alveolar tissues.

The ruptured tissue leaks air. And finally air travel to the subcutaneous tissue through mediastinum.

Causes of subcutaneous emphysema?

The primary cause of subcutaneous emphysema is injury or trauma.

As we know, whenever we breathe, air goes into the lungs. The air is then circulated all over the body. But, due to trauma or injury, the tissue of the airway, lungs or digestive tract ruptures.

The ruptured tissue leaks air into surrounding tissues and eventually air travel to the tissue beneath the skin. Here it gets accumulated as an air bubble or air sac. Therefore, the major sites for subcutaneous emphysema are proximal to the lungs such as chest, face, and neck.

Let us look into some of the causes of subcutaneous emphysema.

Chest trauma: Whenever you experience and trauma at your chest region, there are chances that will have emphysema on the chest wall. During any car accident, collision or when something sharp penetrates your chest, alveoli of your ling ruptures. Such injury to the alveoli is very much similar to the pulmonary laceration. The pulmonary laceration is any sort of injury or cuts in the lung tissue.

Beside this, there are several other reasons for subcutaneous emphysema.

Formation of gas gangrene: Gas gangrene is also an important cause of subcutaneous emphysema. Gas gangrene is the local accumulation of gas. It happens due to due to bacterial infection. Bacteria Clostridium plays a major role in the formation of gas in case of gas gangrene.

Surgery: Any surgical procedure of the thorax such endoscopy or bronchoscopy can rupture the air passage or lungs tissue. Further, it can result in subcutaneous emphysema. If any of this surgical procedure causes you emphysema, we call it surgical emphysema. Sometimes injury by pneumatic tools can cause emphysema in limbs such as legs, hands, etc.

Unknown reason: Sometimes, the real cause of emphysema is not clear. Therefore, we call spontaneous subcutaneous emphysema to such conditions. Spontaneous subcutaneous emphysema treatment is not that easy because we don’t know the cause.

Diagnosis of subcutaneous emphysema?

Before the subcutaneous emphysema treatment, the diagnosis of the disease is necessary. So that we can rule out other medical conditions as well.

The presence of subcutaneous emphysema can be easily detectable by the signs and symptoms. However, sometimes the symptoms are not enough to detect the condition. During such a case, a medical imaging technique is used to diagnose it.

Following are the diagnostic examinations for subcutaneous emphysema.

Radiograph: Radiography of the chest shows radiolucent striations. Air in the chest cavity may interfere with the proper radiography. Due to air in the chest cavity, it is not possible to detect a more severe medical condition such as pneumothorax.

Chest x-ray: Chest x-ray can easily detect subcutaneous emphysema.

CT-Scan: CT scan of the lungs can diagnose the medical condition. The dark colour of the scan result shows that the person has an air pocket in his chest. CT-scan is very much effective in detecting the route or the air movement under the skin.

Lung functioning test: The doctor may ask you to go for Lung functioning test. This test can detect if your lung is efficiently to work properly. A device called spirometer is used in this case.

Blood test: The doctor may advise you to go for the blood test to see if the lungs are functioning properly to transfer oxygen.

Pulse oximetry: Pulse oximetry is a method that can detect the amount of oxygen present in your blood.

Subcutaneous emphysema treatment:

Subcutaneous emphysema treatment is not required if the underlying condition is cured. However, the amount of trapped air is so much that it hinders breathing a lot and feel uncomfortable.

Surgery:

Surgery of subcutaneous emphysema is sometimes required as a treatment.

Sometime, subcutaneous may lead to more severe massive subcutaneous emphysema. This condition requires urgent medical intervention and the deposited air is removed by surgical drainage.

Positive pressure ventilation sometimes drains excessive air to the facial subcutaneous tissue. So, the patient may have visual disturbances due to the swelling eyelids.

Moreover, it may hinder the flow of air to the extremities and vital organs such as scrotum, labia and breast leading the necrosis of tissue. In such cases, treatment is required with adequate decompression. Otherwise, extreme pressure on the trachea can build up.

Whenever pneumothorax causes subcutaneous emphysema, the doctor inserts a chest tube into the chest. This is usually done by cutting the skin tissue. The chest tube continuously removes the trapped air. Sometimes, the doctor may do suction of the chest tube to promote the quick release of air.

Catheters are usually placed for the surgical removal of air from the subcutaneous tissue.

We can treat the underlying condition, but sometimes we don’t know the reason causing it in the case of spontaneous subcutaneous emphysema. In such cases, the patient needs to take rest and take painkillers to manage pain.

Oxygen supplements can aid in the reabsorption of some subcutaneous air by the body.

Sometimes, the lung transplant is required in severe cases.

Medications:

There are some medicines that can alleviate the symptoms as well as treat the condition. Here are few listed below:

Bronchodilators such as salbutamol can help to dilate the airway and allow smooth flow of air. This medication can make your breathing easy.

There may be an occurrence of infections, to treat such issue the doctor may prescribe you antibiotics such as azithromycin or amoxicillin.

The doctor can also prescribe you steroid to relieve you from breathing difficulty.

Note: Subcutaneous emphysema is not so scary, because our body has the capacity to absorb a small amount of air. When the underlying condition such as pneumothorax and pneumomediastinum goes away, the condition vanishes itself. However, spontaneous subcutaneous emphysema can pose great danger and may lead to the life-threatening condition. It is because we don’t know the underlying reason for spontaneous subcutaneous emphysema that makes its treatment so difficult.

The takeaway:

Subcutaneous emphysema does not usually require treatment and goes away at its own, because the body can absorb some portion of air. Moreover, once the underlying condition goes away, subcutaneous emphysema vanishes.

A more severe case of the disease such as a massive build-up of air in the subcutaneous tissue requires treatment and surgical removal of air.

Moreover, you can adopt some dietary changes to such, addition of vitamin C, A and E to your diet in the form of fruits and vegetables. These nutrients will boost your immunity. A powerful immune system can prevent you from infections.

If you have any symptoms of the disease, it is advisable to see the doctor. Patients with a severe case of emphysema need to follow the instructions of doctors to prevent any complications.